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Kawamura K, Wakayama S, Osawa A, Ishino S, Iwase T, Tanimoto M, Itoh N, Maeshima S. Effectiveness of Home Exercise Program for Older People approach for frailty: A preliminary study. Geriatr Gerontol Int 2024. [PMID: 38690759 DOI: 10.1111/ggi.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Koki Kawamura
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi, Medical University, Nagakute, Japan
| | - Satomu Wakayama
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Aiko Osawa
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shota Ishino
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taku Iwase
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masanori Tanimoto
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shinichiro Maeshima
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
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Maeshima S, Osawa A, Kawamura K, Yoshimura T, Otaka E, Sato Y, Ueda I, Itoh N, Kondo I, Arai H. Neuropsychological tests used for dementia assessment in Japan: Current status. Geriatr Gerontol Int 2024; 24 Suppl 1:102-109. [PMID: 37746748 DOI: 10.1111/ggi.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
AIM This study aimed to investigate the assessment tools dementia specialists use in clinical practice, reasons for their use and assessment-related factors. METHODS A questionnaire survey was carried out from 15 September 2021 to 20 October 2021 among 1858 dementia specialists in Japan, with responses obtained via mail or using a Web form accessed via a Web address. RESULTS Of the 1858 specialists who were sent the questionnaire, 574 responded, yielding a response rate of 32.2%. Almost all respondents stated that the main purposes of neuropsychological testing were to identify the pathophysiology and aid diagnosis. Most respondents identified behavioral and psychological symptoms of dementia as important factors for assessment. The most commonly used tests were the Hasegawa Dementia Scale-Revised and Mini-Mental State Examination, often used as screening tools. The Mini-Mental State Examination, Clock Drawing Test and Cube Copying Test were common assessments carried out directly by specialists. Quality of life and burden of care were less commonly assessed. CONCLUSIONS Despite the main purpose of carrying out neuropsychological tests on dementia patients is to "understand the pathophysiology" and "aid in diagnosis," many assessment methods were chosen as screening methods carried out in a short time during clinic hours. The lack of evaluation of care burden and QOL, considered important by specialists, is an issue for the future in treating people with dementia, a life disability. Geriatr Gerontol Int 2024; 24: 102-109.
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Affiliation(s)
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Koki Kawamura
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Eri Otaka
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yayoi Sato
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ikue Ueda
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kamizato C, Osawa A, Maeshima S, Kagaya H, Arai H. Activity level by clinical severity and sex differences in patients with Alzheimer disease and mild cognitive impairment. Psychogeriatrics 2023; 23:815-820. [PMID: 37487570 DOI: 10.1111/psyg.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND To determine how to maintain activity in persons with dementia and mild cognitive impairment, we examined the daily activity level by different degrees of clinical severity and sex differences in patients with Alzheimer's disease and mild cognitive impairment. METHODS This study included 92 patients with Alzheimer's disease and 33 patients with mild cognitive impairment who visited our rehabilitation department. The Frenchay Activities Index was used to assess the level of activity. RESULTS Women had high Frenchay Activities Index scores for household activities, such as meal preparation, washing clothes, and light housework, whereas men had high Frenchay Activities Index scores for social occasions and walking outside. Although activity decreased with the severity of dementia in women, there was no difference in men. Additionally, a negative correlation was observed between the number of people living together and activity in women. CONCLUSIONS To maintain and improve activities in persons with Alzheimer's disease and mild cognitive impairment, it is important to suggest activities that fit the lifestyle of the individual and family caregivers and to provide lifestyle instructions that consider sex differences.
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Affiliation(s)
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Hitoshi Kagaya
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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4
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Nakao Y, Kawamura K, Iwase T, Osawa A, Maeshima S, Arai H. Decrease in 6-min walk distance among frail older people. Geriatr Gerontol Int 2023; 23:248-249. [PMID: 36746432 DOI: 10.1111/ggi.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Yuto Nakao
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Koki Kawamura
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taku Iwase
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Aiko Osawa
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shinichiro Maeshima
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
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Yoshitake M, Maeshima E, Maeshima S, Osawa A, Ito N, Ueda I, Kamiya M. Olfactory identification ability in patients with mild cognitive impairment and Alzheimer's disease. J Phys Ther Sci 2022; 34:710-714. [PMID: 36337215 PMCID: PMC9622342 DOI: 10.1589/jpts.34.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
[Purpose] To examine the olfactory identification abilities and specify the
difficult-to-identify odors in community-dwelling individuals with mild cognitive
impairment (MCI) and Alzheimer’s disease (AD). [Participants and Methods] We included, 12
and 17 patients with MCI (MCI group) and AD (AD group), respectively, and 30
community-dwelling older adults with no history of MCI or a dementia diagnosis (control
group). Scores on the Japanese odor stick identification test (OSIT-J), an olfactory
identification ability test, were compared among the three groups with intergroup
differences examined accordingly. Next, we performed intergroup comparisons of the ratios
of correct responses for each odor, and the difficult-to-identify odors were examined.
[Results] OSIT-J scores of the MCI and AD groups were significantly lower than those of
the control group. There were no intergroup differences in the correct identification of
pungent odors. No patients in the AD group could identify the odor of cooking gas. The
ability to identify food-related odors was reduced in the MCI and AD groups. [Conclusion]
Patients with MCI and AD had reduced olfactory identification abilities in comparison to
community-dwelling older adults without cognitive decline. These findings suggest the
importance of olfactory evaluation before providing patients with dementia with
therapeutic interventions associated with olfactory stimuli.
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Affiliation(s)
- Masashi Yoshitake
- Faculty of Health Sciences, Kinjo University: 1200
Kasama-machi, Hakusan-shi, Ishikawa 924-8511, Japan, Graduate School of Osaka University of Health and Sport
Sciences, Japan,Corresponding author. Masashi Yoshitake (E-mail: )
| | - Etsuko Maeshima
- Graduate School of Osaka University of Health and Sport
Sciences, Japan
| | - Shinichiro Maeshima
- Education and Innovation Center for Geriatrics and
Gerontology, National Center for Geriatrics and Gerontology, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology, Japan
| | - Naoki Ito
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology, Japan
| | - Ikue Ueda
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology, Japan
| | - Masaki Kamiya
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology, Japan
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Yoshitake M, Maeshima E, Maeshima S, Sasaki K, Osawa A. Association between cognitive function and olfactory identification ability in community-dwelling older individuals. J Phys Ther Sci 2022; 34:459-462. [PMID: 35698550 PMCID: PMC9170479 DOI: 10.1589/jpts.34.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We investigated whether olfactory identification ability may be useful for early detection of cognitive decline. [Participants and Methods] The study included 55 community-dwelling older individuals without a history of mild cognitive impairment or dementia, who were capable of living independently. Cognitive function was evaluated using the Japanese versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment tools. The olfactory identification ability was evaluated using the Odor Stick Identification Test for the Japanese. We also investigated the association between olfactory identification ability and cognitive function. [Results] Based on the Japanese version of the Mini-Mental State Examination, all participants were categorized into the noncognitive decline group, and based on the Japanese version of the Montreal Cognitive Assessment tool, 21 participants were categorized into the cognitive decline group. With regard to olfactory discrimination ability, we observed a significant difference between participants with and without cognitive decline based on the Japanese version of the Montreal Cognitive Assessment scores. Furthermore, we observed a significant positive correlation between the Japanese version of the the Montreal Cognitive Assessment scores and the Odor Stick Identification Test for the Japanese scores, although no significant correlation was observed between the Japanese version of the Mini-Mental State Examination and the Odor Stick Identification Test for the Japanese scores. [Conclusion] Olfactory identification ability may be useful to detect early-stage cognitive decline in community-dwelling older individuals.
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Affiliation(s)
- Masashi Yoshitake
- Faculty of Health Sciences, Kinjo University: 1200
Kasama-machi, Hakusan-shi, Ishikawa 924-8511, Japan
- Graduate School of Osaka University of Health and Sport
Sciences, Japan
| | - Etsuko Maeshima
- Graduate School of Osaka University of Health and Sport
Sciences, Japan
| | - Shinichiro Maeshima
- Faculty of Health Sciences, Kinjo University: 1200
Kasama-machi, Hakusan-shi, Ishikawa 924-8511, Japan
| | - Kentaro Sasaki
- Faculty of Health Sciences, Kinjo University: 1200
Kasama-machi, Hakusan-shi, Ishikawa 924-8511, Japan
| | - Aiko Osawa
- Department of Rehabilitation, National Center for
Geriatrics and Gerontology, Japan
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Osawa A, Maeshima S, Arai H. Applying Information and Communication Technology to Promote Healthy Aging in Older People: Japan’s Challenges and Perspective. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-healthy-aging-japan] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yokota A, Maeshima E, Maeshima S, Ooi T, Sasaki K. Physical function and health-related quality of life of community-dwelling older adults with locomotive syndrome and pre-frailty. J Phys Ther Sci 2022; 34:440-444. [PMID: 35698551 PMCID: PMC9170484 DOI: 10.1589/jpts.34.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ayako Yokota
- School of Medical Health, Kinjo University: 1200 Kasama, Hakusan city, Ishikawa 924-8511, Japan
| | - Etsuko Maeshima
- Graduate School of Sport Sciences, Osaka University of Health and Sport Sciences, Japan
| | | | - Takafumi Ooi
- Course of Rehabilitation, Kinjo University Graduate School, Japan
| | - Kentaro Sasaki
- Course of Rehabilitation, Kinjo University Graduate School, Japan
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Maeshima S, Osawa A, Kondo I, Kamiya M, Ueda I, Sakurai T, Arai H. Differences in instrumental activities of daily living between mild cognitive impairment and Alzheimer's disease: A study using a detailed executive function assessment. Geriatr Gerontol Int 2021; 21:1111-1117. [PMID: 34643324 DOI: 10.1111/ggi.14295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/13/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022]
Abstract
AIM Executive dysfunction is pathognomonic for dementia and impedes the activities of daily living (ADL). This study aimed to examine the relationship of dementia severity with executive dysfunction and ADL in mild cognitive impairment and dementia. METHODS This single-center study enrolled 86 patients (men, 40; women, 46; mean age, 76.1 ± 7.5 years) referred for cognitive and physical rehabilitation between October 2015 and September 2020. The Clinical Dementia Rating (CDR) was 0.5, 1, and ≥2 in 45, 30, and 11 patients, respectively. The presence and severity of executive dysfunction were assessed using the Behavioral Assessment of the Dysexecutive Syndrome-Japanese version (BADS). The ADL and instrumental ADL (IADL) were assessed using the Barthel Index and Frenchay Activities Index (FAI), respectively. We examined the relationship between CDR severity and overall BADS profile score and its sub-items, and that between the overall BADS profile score and IADL. RESULTS The cognitive and executive functional assessment scores differed significantly depending on the CDR severity. The CDR severity and overall BADS profile score exhibited significant correlations. The BADS found cognitive impairment in 31%, 70%, and 100% of patients with CDR0.5, CDR1, and CDR≥2, respectively. The FAI score differed according to the CDR severity in women but not in men. The overall profile and age-adjusted BADS scores were strongly correlated with the IADL in women but not in men. CONCLUSIONS The greater the severity of executive dysfunction, the greater the difficulty in performing ADL. This effect was more pronounced in women and may predict dementia progression. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masaki Kamiya
- Division of Rehabilitation Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ikue Ueda
- Division of Rehabilitation Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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10
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Yoshimura T, Osawa A, Maeshima S. Assessment of cube-copying among community-dwelling elderly living in Japan using the vertex criterion and parallelism. Psychogeriatrics 2021; 21:722-729. [PMID: 34107552 DOI: 10.1111/psyg.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cube-copying test is used to assess cognitive function. It is one of the methods used to distinguish healthy older individuals from those with cognitive impairment based on its 3 mm vertex criterion and parallel line errors. We sought to assess how: (1) precisely elderly community-dwelling individuals draw cubes based on two different vertex criteria; and (2) they keep the parallelism of lines. METHODS The cross-sectional design study population comprised 121 adults ((outlier analysis excluded the results of three, resulting in 118 participants) ≥ 65 years (21 men and 100 women) who participated in an annual physical fitness circuit and who lived independently in their communities. We recorded the participants' ages, years of education, and the scores they obtained in the Japanese version of the Montreal Cognitive Assessment. Participants were instructed to draw the cube as precisely as possible. Cube drawings were assessed based on the correct position of the vertices using 1 and 3 mm criteria and parallel line errors. RESULTS Eighty-nine percent of the participants were able to draw vertices within 3 mm distance from the correct position but found it difficult to draw them within 1 mm distance. Using the 3 mm vertex criterion, the mean score for correct vertices was six (out of a maximum of eight). Most of the participants made a maximum of one out of six possible parallel line errors. CONCLUSIONS Almost 90% of the elderly in our study drew the vertices within 3 mm of the correct position, and the parallel line errors were few. The 3 mm vertex and parallel line criteria by cube-copying seem to be cleared by most community-dwelling elderly. Further research should determine if participants aged ≥85 years with less than 6 years of education show different results.
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Affiliation(s)
- Takako Yoshimura
- Department of Speech and Hearing Sciences and Disorders, Kyoto University of Advanced Science, Kyoto, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Centre for Geriatrics and Gerontology, Obu, Japan
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11
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Yoshimura T, Osaka M, Osawa A, Maeshima S. The classical backward digit span task detects changes in working memory but is unsuitable for classifying the severity of dementia. Appl Neuropsychol Adult 2021:1-7. [PMID: 34410864 DOI: 10.1080/23279095.2021.1961774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Dementia is characterized by the deterioration of working memory (WM). The backward digit span (DS) task and reading span test (RST) are measures of WM. DS task and RST have not been directly compared in assessing dementia. This study aimed to compare the performance of individuals with dementia in forward and backward DS tasks to that in RST. We investigated the ability of forward/backward DS tasks to discriminate dementia severity. Forward/backward DS tasks and RST were performed in 15 elderly Japanese individuals with dementia. Twenty-six and 20 elderly individuals for the DS task and RST, respectively, were included as controls. Clinical Dementia Rating scale (CDR) was used to evaluate dementia severity. DS task scores were significantly correlated with RST scores. Both types of DS tasks correlated with RST, only the RST distinguished dementia severity based on CDR. Our findings indicate that the backward DS task may detect WM decline in dementia, but the RST is more suitable for assessing dementia severity. The backward DS task may be an effective screening measure for dementia signs in the elderly and may be used to identify patients requiring further assessments such as the RST to evaluate dementia severity based on WM performance.
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Affiliation(s)
| | - Mariko Osaka
- Center for Information and Neural Networks, Osaka, Japan
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kamiya A, Noguchi M, Kibayashi T, Maeshima S, Osawa A, Arai H. Video demonstrating NCGG-HEPOP 2020 exercises for older adults. Geriatr Gerontol Int 2021; 21:871-872. [PMID: 34310006 DOI: 10.1111/ggi.14241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/20/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Akio Kamiya
- Course of Comprehensive Rehabilitation, Kinjo University Graduate School, Hakusan, Japan
| | - Masahiro Noguchi
- Course of Comprehensive Rehabilitation, Kinjo University Graduate School, Hakusan, Japan
| | - Tsutomu Kibayashi
- Course of Comprehensive Rehabilitation, Kinjo University Graduate School, Hakusan, Japan
| | - Shinichiro Maeshima
- Course of Comprehensive Rehabilitation, Kinjo University Graduate School, Hakusan, Japan
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Nakajima T, Sankai Y, Takata S, Kobayashi Y, Ando Y, Nakagawa M, Saito T, Saito K, Ishida C, Tamaoka A, Saotome T, Ikai T, Endo H, Ishii K, Morita M, Maeno T, Komai K, Ikeda T, Ishikawa Y, Maeshima S, Aoki M, Ito M, Mima T, Miura T, Matsuda J, Kawaguchi Y, Hayashi T, Shingu M, Kawamoto H. Cybernic treatment with wearable cyborg Hybrid Assistive Limb (HAL) improves ambulatory function in patients with slowly progressive rare neuromuscular diseases: a multicentre, randomised, controlled crossover trial for efficacy and safety (NCY-3001). Orphanet J Rare Dis 2021; 16:304. [PMID: 34233722 PMCID: PMC8261928 DOI: 10.1186/s13023-021-01928-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rare neuromuscular diseases such as spinal muscular atrophy, spinal bulbar muscular atrophy, muscular dystrophy, Charcot-Marie-Tooth disease, distal myopathy, sporadic inclusion body myositis, congenital myopathy, and amyotrophic lateral sclerosis lead to incurable amyotrophy and consequent loss of ambulation. Thus far, no therapeutic approaches have been successful in recovering the ambulatory ability. Thus, the aim of this trial was to evaluate the efficacy and safety of cybernic treatment with a wearable cyborg Hybrid Assistive Limb (HAL, Lower Limb Type) in improving the ambulatory function in those patients.
Results We conducted an open-label, randomised, controlled crossover trial to test HAL at nine hospitals between March 6, 2013 and August 8, 2014. Eligible patients were older than 18 years and had a diagnosis of neuromuscular disease as specified above. They were unable to walk for 10 m independently and had neither respiratory failure nor rapid deterioration in gait. The primary endpoint was the distance passed during a two-minute walk test (2MWT). The secondary endpoints were walking speed, cadence, and step length during the 10-m walk test (10MWT), muscle strength by manual muscle testing (MMT), and a series of functional measures. Adverse events and failures/problems/errors with HAL were also evaluated. Thirty patients were randomly assigned to groups A or B, with each group of 15 receiving both treatments in a crossover design. The efficacy of a 40-min walking program performed nine times was compared between HAL plus a hoist and a hoist only. The final analysis included 13 and 11 patients in groups A and B, respectively. Cybernic treatment with HAL resulted in a 10.066% significantly improved distance in 2MWT (95% confidence interval, 0.667–19.464; p = 0.0369) compared with the hoist only treatment. Among the secondary endpoints, the total scores of MMT and cadence at 10MWT were the only ones that showed significant improvement. The only adverse effects were slight to mild myalgia, back pain, and contact skin troubles, which were easily remedied.
Conclusions HAL is a new treatment device for walking exercise, proven to be more effective than the conventional method in patients with incurable neuromuscular diseases. Trial registration: JMACTR, JMA-IIA00156
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Affiliation(s)
- Takashi Nakajima
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan.
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,CYBERDYNE Inc., Tsukuba, Japan
| | - Shinjiro Takata
- Department of Orthopedics and Rehabilitation, National Hospital Organization Tokushima National Hospital, Yoshinogawa, Japan
| | - Yoko Kobayashi
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshihito Ando
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masanori Nakagawa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Shinjuku, Japan
| | - Chiho Ishida
- Department of Neurology, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takako Saotome
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Tetsuo Ikai
- Department of Rehabilitation, Tokyo Women's Medical University, Shinjuku, Japan
| | - Hisako Endo
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan
| | - Kazuhiro Ishii
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mitsuya Morita
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Maeno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kiyonobu Komai
- Department of Neurology, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Tetsuhiko Ikeda
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan
| | - Yuka Ishikawa
- Department of Pediatric Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiya Ito
- Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Mima
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshihiko Miura
- Department of Rehabilitation, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Jun Matsuda
- Graduate School of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan
| | | | | | | | - Hiroaki Kawamoto
- CYBERDYNE Inc., Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
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15
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Mori S, Osawa A, Maeshima S, Sakurai T, Ozaki K, Kondo I, Saitoh E. Possibility of Using Quantitative Assessment with the Cube Copying Test for Evaluation of Visuo-spatial Function in Patients with Alzheimer's Disease. Prog Rehabil Med 2021; 6:20210021. [PMID: 33937549 PMCID: PMC8080165 DOI: 10.2490/prm.20210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives: The aim of this study was to investigate the clinical usefulness of the Cube Copying
Test (CCT) for quantitative assessment of visuo-spatial function in patients with
Alzheimer’s disease (AD). Methods: The CCT, Raven’s Colored Progressive Matrices (RCPM), and other neuropsychological
tests were administered to 152 AD outpatients. For the quantitative assessment of CCT,
we scored the points of connection (POC) and the number of plane-drawing errors (PDE)
and categorized the pattern classification (PAC). We also measured Functional Assessment
Staging (FAST) to assess the severity of AD. The relationships among CCT, RCPM, and FAST
were then analyzed. Results: The mean POC and PDE scores were 2.7 and 3.6, respectively, and the median PAC score
was 6.0. PDE and PAC showed a linear relationship, but POC and PDE, and POC and PAC did
not. Each component of CCT showed a significant correlation with RCPM scores. PDE and
PAC had closer correlations with RCPM scores than POC did. The PDE and PAC results were
significantly different among most of the FAST stages. Conclusions: Quantitative assessment using CCT may be effective for the quick determination of the
visuo-spatial function in AD patients.
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Affiliation(s)
- Shino Mori
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Osawa A, Arai H, Maeshima S. Usefulness of a computerized cognitive assessment and training tool for detecting dementia. Geriatr Gerontol Int 2021; 21:438-439. [PMID: 33752258 DOI: 10.1111/ggi.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kawamura K, Kamiya M, Suzumura S, Maki K, Ueda I, Itoh N, Osawa A, Maeshima S, Arai H, Kondo I. Impact of the Coronavirus Disease 2019 Outbreak on Activity and Exercise Levels among Older Patients. J Nutr Health Aging 2021; 25:921-925. [PMID: 34409972 PMCID: PMC8231075 DOI: 10.1007/s12603-021-1648-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study aimed to clarify the impact of the coronavirus disease 2019 outbreak on the levels of activity among older patients with frailty or underlying diseases. A total of 175 patients (79.0±7.0 years) undergoing outpatient or home-based rehabilitation, stratified into groups, based on frailty status. The percentage of patients who went out at least once a week decreased after the outbreak from 91% to 87%, from 65% to 46%, and from 47% to 36% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in exercise during the outbreak was 75%, 51%, and 41% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in voluntary exercise after instruction was lowest in the frail group (35%). Older patients with frailty are susceptible to the negative effects of refraining from physical activity and require careful management.
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Affiliation(s)
- K Kawamura
- Aiko Osawa, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi 474-8511, Japan, Tel: +81-562-46-2311, Fax: +81-562-48-2373, E-mail:
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Osawa A, Maeshima S, Arai H, Kondo I. Dementia with aphasia and mirror phenomenon: examination of the mechanism using neuroimaging and neuropsychological findings: a case report. BMC Neurol 2020; 20:425. [PMID: 33228544 PMCID: PMC7684751 DOI: 10.1186/s12883-020-01994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aphasia often appears in persons living with dementia; however, aphasia and the mirror phenomenon are rarely present at the same time. CASE PRESENTATION Here, we report a case of fluent conversation with a person in a mirror or a magazine, and examine the underlying mechanism using brain imaging and neuropsychological findings. We found that the appearance of the mirror phenomenon may be associated with a visuospatial dysfunction caused by a decreased function of the posterior region of the right temporal and parietal lobe. Moreover, active talking to a person in a mirror or a person in a magazine could be associated with disinhibition caused by a decline in bilateral frontal lobe function. CONCLUSIONS This case represents a very valuable and interesting presentation because it is the first report of a long-term follow-up of the course of dementia using neurological imaging, and of the neuropsychological analysis of the mechanism of conversation with a mirror image combined with aphasia.
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Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan.
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan
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20
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Osawa A, Arai H, Maeshima S. Reconsidering the effects of active standing‐up exercise in stroke rehabilitation. Geriatr Gerontol Int 2020; 20:1096-1097. [DOI: 10.1111/ggi.14037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine National Center for Geriatrics and Gerontology Aichi Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology Aichi Japan
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21
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Osawa A, Maeshima S, Kondo I, Arai H. Balancing infection control and frailty prevention during and after the COVID-19 pandemic: Introduction of the National Center for Geriatrics and Gerontology Home Exercise Program for Older People Home Exercise Program for Older People 2020. Geriatr Gerontol Int 2020; 20:846-848. [PMID: 32639083 PMCID: PMC7362034 DOI: 10.1111/ggi.13991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Watanabe M, Takeda K, Maeshima S, Suzuki T, Sonoda S. Influence of hematoma volume and age on cognitive functions and ADL after putaminal hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:105063. [PMID: 32807468 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE After cerebral hemorrhage, cognitive functions and activities of daily living (ADL) are affected by various factors, including hematoma volume and patient age. In the present study, we investigated the effect of age and hematoma volume on cognitive functions and on ADL. METHODS The sample comprised 274 patients (183 men and 91 women; mean age 58.2 ± 12.5 years) with putaminal hemorrhage who were hospitalized in a convalescent rehabilitation ward. Hematoma volume was estimated from computed tomography imaging at stroke onset. Cognitive functions were evaluated using Raven's Colored Progressive Matrices test (RCPM) and the Mini-Mental State Examination (MMSE) at hospital admission, while ADL score was assessed at discharge using the Functional Independence Measure motor subscale (FIM-M). In the present study, we classified the patients into six groups according to whether they were non-elderly or elderly (cutoff age, 60 years) and whether their hematoma was small, medium, or large (cutoff volumes, 20 and 40 mL, respectively). Subsequently, the scores on the RCPM, MMSE, and FIM-M were compared among the groups. RESULTS In both age groups, patients with a larger hematoma volume had lower RCPM and MMSE scores. Patients <60 years old exhibited different trends in their RCPM and MMSE scores, such that the RCPM score showed a step-wise decrease according to hematoma volume, while a difference in the MMSE score was only observed at the 20 mL boundary. Most of the younger patients (<60 years of age) attained high FIM-M scores at discharge, as long as their hematoma volume was either medium or small (<40 mL). This age group had higher RCPM scores on admission, which may have contributed to their higher FIM-M scores on discharge. CONCLUSIONS In the present study, we demonstrated that advancing age increases the effect of hematoma volume on RCPM and MMSE scores and identified differences in the effects observed on these two scores. Thus, it may be important to use the RCPM alongside the MMSE for patient assessment.
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Affiliation(s)
- Makoto Watanabe
- Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodori-cho, Tsu, Mie 514-1295, Japan.
| | - Kotaro Takeda
- Faculty of Rehabilitation, School of Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | | | - Takaji Suzuki
- Faculty of Rehabilitation, School of Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1, Oodori-cho, Tsu, Mie 514-1295, Japan
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Maeshima S, Okamoto S, Mizuno S, Okazaki H, Sonoda S. Predicting walking ability in hemiplegic patients with putaminal hemorrhage: an observational study in a rehabilitation hospital. Eur J Phys Rehabil Med 2020; 57:321-326. [PMID: 31976635 DOI: 10.23736/s1973-9087.20.05823-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In stroke rehabilitation, the most important concern of the patients and their families is whether the patients can walk independently and whether they need braces after discharge. AIM This study aims to investigate the relationship between several types of putaminal hemorrhage and walking independence and orthotic therapy in patients with hemiplegia. DESIGN Observational study. SETTING Inpatients rehabilitation department, Fujita Health University Nanakuri Memorial Hospital, Japan. POPULATION Total 264 patients with putaminal hemorrhage admitted to our hospital. METHODS Neurological and cognitive functions were examined as per the stroke scale of the National Institutes of Health and the Mini-mental state examination, respectively. The hematomas were classified into five types, and the volume was measured using computed tomography (CT). Walking ability was evaluated by Functional Ambulation Category (FAC), and walking independence was defined as FAC ≥4. The relationship between the types of hematomas and walking independence and orthotic therapy in patients with hemiplegia with putaminal hemorrhage was also analyzed. RESULTS We observed differences within the hematoma types in volume, neurological symptoms, and cognitive function but not in age, sex, and lesion side aspects of these patients - 143 of whom could walk independently (FAC≥4) and 121 non-independently. Walking independently and the need for orthosis were closely related to the type of hematoma. CONCLUSIONS CT imaging at stroke onset can provide useful information when examining walking independence and indicate necessity for an orthosis at the time of discharge to the rehabilitation ward. CLINICAL REHABILITATION IMPACT This study might help to better understand the role of neuroimaging in stroke rehabilitation.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine II, Fujita Health University, Tsu, Japan - shinichiromaeshima @gmail.com
| | - Sayaka Okamoto
- Department of Rehabilitation Medicine II, Fujita Health University, Tsu, Japan
| | - Shino Mizuno
- Department of Rehabilitation Medicine II, Fujita Health University, Tsu, Japan
| | - Hideto Okazaki
- Department of Rehabilitation Medicine II, Fujita Health University, Tsu, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, Fujita Health University, Tsu, Japan
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Maeshima S, Okamoto S, Okazaki H, Maeda H, Fuse I, Hori H, Yagihashi K, Senju Y, Kiso A, Sonoda S. Factors necessary for independent walking in patients with putaminal hemorrhage. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mizuno S, Takeda K, Maeshima S, Shigeru S. Effect of oral baclofen on spasticity poststroke: responders versus non-responders. Top Stroke Rehabil 2018; 25:438-444. [PMID: 29768106 DOI: 10.1080/10749357.2018.1474422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective To assess quantitatively the efficacy of oral baclofen for spasticity poststroke. Methods The participants were 29 persons poststroke with increased resistance to passive ankle dorsiflexion and ankle clonus on clinical assessment. Baclofen was administered at 20 mg/day for 1 week. The ankle joint was passively dorsiflexed at either 5°/s (slow stretch) or 90°/s (fast stretch) by a custom-built device. The ankle joint angle and resistive torque were measured during the ramp-and-hold stretch, with gastrocnemius electromyogram. The main outcome measures were the numbers of ankle clonus during hold, and the torques at 10° of ankle dorsiflexion in slow stretch (T-slow) and fast stretch (T-fast). Moreover, the velocity-dependent torque (ΔT = T-fast - T-slow) was compared between before and after oral baclofen. Results The numbers of ankle clonus, T-slow, T-fast, and ΔT for all participants did not exhibit significant differences between before and after baclofen administration. However, reduction in the number of ankle clonus of five or more was accompanied with a reduction in ΔT (4.0 ± 1.8 Nm) in three participants (the responders). Conclusion Although the responder rate was low, some participants responded to oral baclofen. Thus, a short-term trial of oral baclofen, and quantitative and electrophysiological assessments of muscle tone and ankle clonus are recommended.
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Affiliation(s)
- Shiho Mizuno
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
| | - Kotaro Takeda
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Shinichiro Maeshima
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
| | - Sonoda Shigeru
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
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Hiraoka S, Maeshima S, Okazaki H, Hori H, Tanaka S, Okamoto S, Funahashi R, Yagihashi K, Fuse I, Asano N, Sonoda S. Factors necessary for independent walking in patients with thalamic hemorrhage. BMC Neurol 2017; 17:211. [PMID: 29216828 PMCID: PMC5721668 DOI: 10.1186/s12883-017-0991-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Thalamic hemorrhages cause motor paralysis, sensory impairment, and cognitive dysfunctions, all of which may significantly affect walking independence. We examined the factors related to independent walking in patients with thalamic hemorrhage who were admitted to a rehabilitation hospital. Methods We evaluated 128 patients with thalamic hemorrhage (75 men and 53 women; age range, 40–93 years) who were admitted to our rehabilitation hospital. The mean duration from symptom onset to rehabilitation hospital admission was 27.2 ± 10.3 days, and the mean rehabilitation hospital stay was 71.0 ± 31.4 days. Patients’ neurological and cognitive functions were examined with the National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE), respectively. The relationship between patients’ scores on these scales and their walking ability at discharge from the rehabilitation hospital was analyzed. Additionally, a decision-tree analysis was used to create a model for predicting independent walking upon referral to the rehabilitation hospital. Results Among the patients, 65 could walk independently and 63 could not. The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, hematoma type, hematoma volume, neurological symptoms, and cognitive function. The decision-tree analysis revealed that the patient’s age, NIHSS score, MMSE score, hematoma volume, and presence of ventricular bleeding were factors that could predict independent walking. Conclusions In patients with thalamic hemorrhage, the neurological symptoms, cognitive function, and neuroimaging factors at onset are useful for predicting independent walking.
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Affiliation(s)
- Shigenori Hiraoka
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan. .,Department of Rehabilitation Medicine, Fujita Health University, Nanakuri Memorial Hospital, 114-2 Oodoricho, Tsu, Mie, 514-1295, Japan.
| | - Hideto Okazaki
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Hirokazu Hori
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Shinichiro Tanaka
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Sayaka Okamoto
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Reisuke Funahashi
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Kei Yagihashi
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Ikuko Fuse
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Naoki Asano
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
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Maeshima S, Okamoto S, Okazaki H, Funahashi R, Hiraoka S, Hori H, Yagihashi K, Fuse I, Tanaka S, Asano N, Sonoda S. Aphasia Following Left Putaminal Hemorrhage at a Rehabilitation Hospital. Eur Neurol 2017; 79:33-37. [DOI: 10.1159/000471921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
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Mizuno S, Sonoda S, Takeda K, Maeshima S. Effect of muscle tone on ankle kinetics during gait with ankle-foot orthoses in persons with stroke. Top Stroke Rehabil 2017; 24:567-572. [PMID: 28945975 DOI: 10.1080/10749357.2017.1373930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Individuals exhibiting hemiplegia and increased ankle plantar flexors muscle tone following stroke are frequently prescribed an ankle-foot orthosis (AFO) to regain functional ambulation. The effect of muscle tone on ankle kinetics when walking with an AFO remains unknown. Objectives To investigate the effect of plantar flexion (PF) muscle tone on ankle plantar flexion torque during walking with an ankle-foot orthosis Methods The study included 80 participants with first-ever stroke whose manual muscle testing (MMT) of ankle DF 0-4, and 10 healthy subjects. Participants were instructed to walk on a treadmill, at a comfortable speed, wearing an instrumented AFO. Minimum PF torque during the last half of swing was extracted as an outcome measure. Resistive PF torques during passive slow and fast stretches were measured with a custom-built device, with torques at 10° DF (T10°-slow and T10°-fast) extracted as defining parameters for stiffness and muscle tone, respectively. Results Correlations between both T10°-slow and T10°-fast variables with minimum PF torque were fair among ankle DF MMT 0-3 groups (r = 0.71 -0.74, p < 0.01), with no correlation observed among the MMT 4 group and healthy subjects. Conclusions Effects of muscle tone on ankle kinetics during swing phase, with an AFO, were observed in persons with severe ankle DF paresis. Quantitative evaluation of ankle kinetics during gait with an AFO in addition to evaluation of muscle tone at rest is contributory to objective assessment of a muscle tone, not subjective rating scale at rest, or visual inspection of walking.
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Affiliation(s)
- Shiho Mizuno
- a Department of Rehabilitation Medicine , Matsusaka Central General Hospital , Matsusaka , Japan
| | - Shigeru Sonoda
- b Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Toyoake , Japan
| | - Kotaro Takeda
- c Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Shinichiro Maeshima
- b Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Toyoake , Japan
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30
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Asano N, Maeshima S, Okamoto S, Okazaki H, Sonoda S. Thalamic Amnesia Accompanying Disruption of Pain Memory: A Case of Right Anterior Thalamic Infarction and a Subsequent Vertebral Compression Fracture. Pain Med 2017; 18:997-1000. [PMID: 28339538 DOI: 10.1093/pm/pnw277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoki Asano
- Department of Rehabilitation, Nanakuri memorial hospital, Fujita Health University, Mie, Japan
| | - Shinichiro Maeshima
- Department of Rehabilitation, Nanakuri memorial hospital, Fujita Health University, Mie, Japan
| | - Sayaka Okamoto
- Department of Rehabilitation, Nanakuri memorial hospital, Fujita Health University, Mie, Japan
| | - Hideto Okazaki
- Department of Rehabilitation, Nanakuri memorial hospital, Fujita Health University, Mie, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation, Nanakuri memorial hospital, Fujita Health University, Mie, Japan
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Masuo O, Terada T, Tsuura M, Kinoshita Y, Yokote H, Itakura T, Yamaga H, Maeshima S, Ozaki F, Moriwaki H, Oobayashi S, Kuwata T, Hyoutani G, Nishiguchi T. The Strategy of Dural Arteriovenous Fistula with Isolated Sinus. Interv Neuroradiol 2016; 4 Suppl 1:113-6. [DOI: 10.1177/15910199980040s124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/1998] [Accepted: 08/25/1998] [Indexed: 11/16/2022] Open
Abstract
We treated 7 cases of dural arteriovenous fistulas (dAVF) with isolated sinus by transvenous direct embolization. The fistulas located in the transverse-sigmoid sinus in 5 cases, superior sagittal sinus in 1 case and transverse-sigmoid and superior sagittal sinus in 1 case. The initial symptoms were generalized convulsion in 2 cases, disturbed consciousness in 1 case, tinnitus in 2 cases and transient ischemic attack in 2 cases. We performed sinus packing with coils in all cases following transarterial embolization. All patients improved neurologically after the treatments and AVFs completely disappeared in all cases.
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Maeshima S, Okamoto S, Okazaki H, Mizuno S, Asano N, Tsunoda T, Maeda H, Masaki M, Sonoda S. Hemorrhagic Transformation in Patients with Cerebral Infarction Referred to a Rehabilitation Hospital. Interv Neurol 2016; 4:69-74. [PMID: 27051401 DOI: 10.1159/000439548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of our study was to investigate the presenting conditions of patients with hemorrhagic transformation (HT), the frequency of HT and its treatments at a rehabilitation hospital. SUBJECTS AND METHODS 165 patients with cerebral infarctions transferred to our rehabilitation hospital during the study period were enrolled. HT was diagnosed by two stroke specialists using computed tomography (CT) at the time of transfer to our rehabilitation hospital and other imaging data from previous consultations. Neurological status, activities of daily living, administered agents, patient age, duration from stroke onset to transfer and length of hospital stay were examined. RESULTS 30 of the 165 patients (18.2%) were diagnosed with HT. Decreased activities of daily living at admission and discharge as well as longer hospitalization stays were more prevalent in HT patients than in those without HT. We did not change antiplatelet or anticoagulant agents, but continued rehabilitation over a defined period while monitoring blood pressure; we confirmed with CT that the patients' physical conditions did not deteriorate. CONCLUSION With careful symptom and CT monitoring over a defined period, rehabilitation can be continued in patients who develop HT at the time of transfer to a rehabilitation hospital in the acute phase of cerebral infarction.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Sayaka Okamoto
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Hideto Okazaki
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Shiho Mizuno
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Naoki Asano
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Tetsuya Tsunoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Hirofumi Maeda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Mitsuko Masaki
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
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Mizuno S, Sonoda S, Takeda K, Maeshima S. Measurement of Resistive Plantar Flexion Torque of the Ankle during Passive Stretch in Healthy Subjects and Patients with Poststroke Hemiplegia. J Stroke Cerebrovasc Dis 2016; 25:946-53. [PMID: 26851973 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Quantification of increased muscle tone for patients with spasticity has been performed to date using various devices to replace the manual scales, such as the modified Ashworth scale or the Tardieu scale. We developed a device that could measure resistive plantar flexion (PF) torque of the ankle during passive dorsiflexion (DF) as an indicator of muscle tone of ankle plantar flexors. METHODS The primary objective was to explore the test-retest intrarater reliability of a custom-built device. Participants were 11 healthy subjects (7 men, 4 women; mean age 47.0 years) and 22 patients with poststroke hemiplegia (11 hemorrhagic, 11 ischemic; 14 men, 8 women; mean age 57.2 years). The device was affixed to the ankle. Subjects were seated with knees either flexed or extended. The ankle was passively dorsiflexed from 20° of PF to more than 10° of DF at 5°/second (slow stretch) or 90°/second (fast stretch). Angle and torque were measured twice during the stretches. The intraclass correlation coefficients (ICCs) of torque at 10° of DF (T10) in the 4 conditions-slow and fast stretches with knee flexed or extended-were calculated. RESULTS The T10 ICCs of the 4 conditions were .95-.99 in both groups. The healthy subjects showed significantly higher T10 of knee extension than of knee flexion during slow and fast stretches. The patients showed increased velocity-dependent torque during fast stretches. CONCLUSIONS Excellent reliability was observed. The device is suitable for measuring resistive PF torque during passive stretch in a flexed knee condition.
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Affiliation(s)
- Shiho Mizuno
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan.
| | - Shigeru Sonoda
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan
| | - Kotaro Takeda
- Fujita Memorial Nanakuri Institute, Fujita Health University, Mie, Japan
| | - Shinichiro Maeshima
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan
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Maeshima S, Okamoto S, Okazaki H, Mizuno S, Asano N, Maeda H, Masaki M, Matsuo H, Tsunoda T, Sonoda S. Potential factors, including activities of daily living, influencing home discharge for patients with putaminal haemorrhage. BMC Neurol 2016; 16:16. [PMID: 26831143 PMCID: PMC4736083 DOI: 10.1186/s12883-016-0539-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Convalescent rehabilitation wards assist stroke patients in acquiring skills for activities of daily living to increase the likelihood of home discharge. However, an improvement in activities of daily living does not necessarily imply that patients are discharged home. We investigated the characteristics of patients with putaminal haemorrhage who are discharged home following convalescence in rehabilitation wards. METHODS The sample comprised 89 patients (58 men and 31 women) with putaminal haemorrhage hospitalised in the convalescent rehabilitation ward of our hospital between August 2012 and July 2013. Their age ranged from 29 to 88 years (61.9 ± 11.9 years). The lesion occurred on the right side in 48 and on the left in 41 patients. The mean period from onset to hospitalisation in the convalescent rehabilitation ward was 30.8 ± 17.2 days, and the mean hospitalisation period was 70.7 ± 31.8 days. We examined age, sex, haematoma volume, duration from onset to hospitalisation, neurological symptoms, cognitive function, functional independence measure, number of cohabitating family members and whether the patient lived alone before stroke, and the relationship among these factors and discharge destination (home or facility/hospital) was assessed. RESULTS The discharge destination was home for 71 and a facility or hospital for 18 patients. Differences were observed in age, haematoma volume, neurological symptoms, cognitive function, functional independence measure score on admission and discharge, number of cohabitating family members and whether the patient lived alone before stroke for patients discharged home. Patients who required long-term care and were discharged home were more likely to be living with family members who were present during daytime. Home discharge was possible if functional independence measure score was ≥70 at the time of discharge for motor items and ≥24 for cognitive items, even if a patient lived alone before stroke. CONCLUSIONS Although the presence of cohabitating family members was important, the factor most strongly influencing home discharge was the patient's activities of daily living status at the time of discharge. For patients who lived alone before stroke, physical and cognitive functions must be maintained for them to be discharged home after rehabilitation.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan. .,Nanakuri Memorial Hospital, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan.
| | - Sayaka Okamoto
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Hideto Okazaki
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Shiho Mizuno
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Naoki Asano
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Hirofumi Maeda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Mitsuko Masaki
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Hiroshi Matsuo
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Tetsuya Tsunoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 424-1 Oodori-cho, Tsu, 514-1295, Japan
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Maeshima S, Tsunoda T, Okamoto S, Ozeki Y, Sonoda S. Alternating Hemiplegia with Ipsilateral Supranuclear Facial Palsy and Abducens Nerve Palsy Caused by Pontine Infarction. Intern Med 2016; 55:2073-5. [PMID: 27477418 DOI: 10.2169/internalmedicine.55.6603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 62-year-old right-handed man was diagnosed with a cerebral infarction in the ventromedial region of the left lower pons. He showed left abducens nerve palsy, left-sided supranuclear palsy of the lower part of the face and right hemiparesis. We hypothesized that the mechanism underlying the patient's ipsilateral supranuclear facial palsy involved the corticofacial fibers after they crossed the midline.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Japan
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Tsunoda T, Maeshima S, Watanabe M, Nagai A, Ueno Y, Ozeki Y, Okamoto S, Mizuno S, Sonoda S. Rehabilitation for a Patient with Hemiplegia, Ataxia, and Cognitive Dysfunction Caused by Pontine Hemorrhage. Case Rep Neurol 2015; 7:213-20. [PMID: 26600785 PMCID: PMC4649740 DOI: 10.1159/000441617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with pontine hemorrhage usually experience severe disturbances of consciousness, pupillary abnormalities, quadriparesis, and respiratory failure. However, little is known regarding cognitive dysfunction in patients with pontine hemorrhage. We report the case of a rehabilitation patient presenting with hemiplegia, ataxia, and cognitive dysfunction caused by a pontine hemorrhage. A 55-year-old, right-handed male suffered sudden onset of vertigo, dysarthria, and hemiplegia on the right side. He was diagnosed with brain stem hemorrhage, and conservative treatment was administered. The vertigo improved, but dysarthria, ataxia, hemiplegia, and gait disorder persisted. He was disoriented with respect to time and place and showed a poor attention span, impaired executive function, and reduced volition. A computed tomography revealed hematomas across the pons on both sides, but no lesions were obvious in the cerebellum and cerebrum. Single-photon emission tomography showed decreased perfusion in the brain stem, bilateral basal ganglia, and frontal and parietal lobes in the left hemisphere. The patient received exercise therapy and cognitive rehabilitation, and home modifications were performed to allow him to continue living at home under the supervision of his family. His symptoms improved, along with enhanced regional cerebral blood flow to the frontal and temporal lobes. These findings suggest that the pontine hemorrhage caused diaschisis resulting in secondary reduction of activity in the cerebral hemisphere and the occurrence of cortical symptoms. Therefore, rehabilitation is necessary, along with active instructions for the family members of patients with severe neurological deficits.
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Affiliation(s)
- Tetsuya Tsunoda
- Department of Rehabilitation Medicine II, School of Medicine, Tsu, Japan
| | | | - Makoto Watanabe
- Rehabilitation Center, Nanakuri Sanatorium, Fujita Health University, Tsu, Japan
| | - Ayako Nagai
- Rehabilitation Center, Nanakuri Sanatorium, Fujita Health University, Tsu, Japan
| | - Yoshiya Ueno
- Rehabilitation Center, Nanakuri Sanatorium, Fujita Health University, Tsu, Japan
| | - Yasunori Ozeki
- Department of Rehabilitation Medicine II, School of Medicine, Tsu, Japan
| | - Sayaka Okamoto
- Department of Rehabilitation Medicine II, School of Medicine, Tsu, Japan
| | - Shiho Mizuno
- Department of Rehabilitation Medicine II, School of Medicine, Tsu, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Tsu, Japan
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Maeshima S, Okazaki H, Okamoto S, Mizuno S, Asano N, Maeda H, Masaki M, Matsuo H, Tsunoda T, Sonoda S. A Comparison of Knee-Ankle-Foot Orthoses with Either Metal Struts or an Adjustable Posterior Strut in Hemiplegic Stroke Patients. J Stroke Cerebrovasc Dis 2015; 24:1312-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 11/29/2022] Open
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Maeshima S, Osawa A, Yamane F, Ishihara S, Tanahashi N. Association between microbleeds observed on T2*-weighted magnetic resonance images and dysphagia in patients with acute supratentorial cerebral hemorrhage. J Stroke Cerebrovasc Dis 2014; 23:2458-63. [PMID: 25183558 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/19/2014] [Accepted: 05/24/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Approximately one-half of all patients with acute intracerebral hemorrhage (ICH) develop dysphagia that can lead to pneumonia or fatal outcomes; however, there are no reports about the relationship between swallowing function and cerebral microbleeds (CMBs) in these patients. Therefore, we investigated whether CMBs were associated with dysphagia in patients with ICH. METHODS A total of 100 patients (mean age, 65.1 ± 14.1 years; range, 36-95 years) with acute supratentorial ICH were included in this study. CMBs were detected on T2*-weighted magnetic resonance imaging performed during admission using a 1.5-T scanner (mean duration from onset to magnetic resonance imaging, 12.6 ± 8.4 days). We assessed swallowing function by using bedside swallowing assessments on admission and by monitoring the mode of nutritional intake at discharge in relation to the number and location of CMBs. RESULTS CMBs were detected in 60 of the 100 patients (60%) and were related to dysphagia. The number of CMBs and dysphagia were not related, but a significant relationship was observed in the presence of bilateral hematomas and CMBs. CONCLUSIONS In addition to assessing just the presence or absence of CMBs, clinicians should identify the presence of bilateral or deep lesions in patients with ICH from the perspective of swallowing dysfunction.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Aiko Osawa
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Fumitaka Yamane
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shoichiro Ishihara
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Norio Tanahashi
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Yoshihara T, Kanazawa R, Maeshima S, Osawa A, Ochiai I, Uemiya N, Kohyama S, Yamane F, Ishihara S. A case of curable dementia treated by effective endovascular embolization for dural arteriovenous fistula. Case Rep Neurol 2014; 6:116-21. [PMID: 24847255 PMCID: PMC4025157 DOI: 10.1159/000362515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background We report a case in which an effective endovascular treatment cured the worsening of dementia due to a dural arteriovenous fistula (dAVF). Case Report A 73-year-old woman suffered for 1.5 years from gait disturbance and disorientation that were suspicious of dementia. A brain MRI revealed that her symptoms were likely due to dAVF. An angiography provided a definitive diagnosis of dural transverse-sigmoid sinus fistula. Transvenous embolization completely occluded the fistula and led to a significant improvement of her cognitive function in tandem with a restoration of the cerebral blood flow. Conclusion Endovascular treatment for dAVF is sometimes effective in treating worsening dementia, which might be due to the drastic change in cerebral blood flow in the area relevant to the cognitive function.
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Affiliation(s)
- Tomoyuki Yoshihara
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Japan
| | - Ryuzaburo Kanazawa
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Japan
| | - Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Aiko Osawa
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Ohbu, Japan
| | - Ikuo Ochiai
- Department of Neurosurgery, Saku Central Hospital, Saku, Japan
| | - Nahoko Uemiya
- Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Fumitaka Yamane
- Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shoichiro Ishihara
- Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Japan
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Maeshima S, Osawa A, Yamane F, Shimaguchi H, Ochiai I, Yoshihara T, Uemiya N, Kanazawa R, Ishihara S. Memory impairment caused by cerebral hematoma in the left medial temporal lobe due to ruptured posterior cerebral artery aneurysm. BMC Neurol 2014; 14:44. [PMID: 24602130 PMCID: PMC3975334 DOI: 10.1186/1471-2377-14-44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive disorders, such as memory disturbances, are often observed following a subarachnoid hemorrhage. We present a very rare case where rupture of a posterior cerebral artery aneurysm caused restricted damage to the hippocampus unilaterally, and caused memory disturbances. CASE PRESENTATION A 56-year-old, right-handed man, with a formal education history of 16 years and company employees was admitted to our hospital because of a consciousness disturbance. He was diagnosed as having a subarachnoid hemorrhage due to a left posterior cerebral artery dissecting aneurysm, and coil embolization was performed. Subsequently, he had neither motor paresis nor sensory disturbances, but he showed disorientation, and both retrograde and anterograde amnesia. Although immediate recall and remote memory were almost intact, his recent memory was moderately impaired. Both verbal and non-verbal memories were impaired. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cerebral hematoma in the left temporal lobe involving the hippocampus and parahippocampal gyrus, and single-photon emission computed tomography (SPECT) demonstrated low perfusion areas in the left medial temporal lobe. CONCLUSIONS We suggest that the memory impairment was caused by local tissue destruction of Papez's circuit in the dominant hemisphere due to the cerebral hematoma.
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Affiliation(s)
- Shinichiro Maeshima
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
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Neki H, Yamane F, Osawa A, Maeshima S, Ishihara S. [Cognitive dysfunction in patients with pontine hemorrhage]. No Shinkei Geka 2014; 42:109-113. [PMID: 24501183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Cognitive dysfunctions with stroke of the brain stem are rare. We focused on and examined cognitive dysfunction after pontine hemorrhages. OBJECT AND METHOD After July 2008, we treated 23 patients with pontine hemorrhages. Only 10 patients were included, all other patients had old hemorrhages, venous anomalies, and disturbances of consciousness. The patients included six men and four women, aged 51 years to 86 years old. The volume of hematoma was 0.11-5.20mL(average:1.74mL);there were six right side, two left side, two bilateral, three ventral, and seven dorsal hematomas. We performed neuropsychological tests such as mini-mental state examination(MMSE), Raven's coloured progressive matrices(RCPM), and frontal assessment battery(FAB). RESULT Eight cases had an abnormal score on the tests. The volume of hematoma showed a high negative correlation with MMSE scores(p=0.0194)and RCPM(p=0.0338). On the other hand, the volume of hematoma and FAB scores(p=0.0832)were uncorrelated, and the localization of the hematoma did not correlate with tests of cognitive function. CONCLUSION Cognitive dysfunction is not rare after pontine hemorrhage. Therefore, for patients with infratentorial lesions, it is necessary to perform detailed cognitive functional tests.
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Affiliation(s)
- Hiroaki Neki
- Division of Endovascular Neurosurgery, Stroke Center, Saitama Medical University International Medical Center
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Maeshima S, Osawa A, Yamane F, Ishihara S, Tanahashi N. Dysphagia following Acute Thalamic Haemorrhage: Clinical Correlates and Outcomes. Eur Neurol 2014; 71:165-72. [DOI: 10.1159/000355477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/01/2013] [Indexed: 11/19/2022]
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Osawa A, Maeshima S, Ozaki K, Kondou I. Causative factors for stroke associated pneumonia and outcome in acute hospital. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
A 71-year-old right-handed man was admitted to our hospital with right hemiparesis and sensory impairment associated with mild aphasia. Although aphasia gradually resolved within 2 weeks after stroke onset, his writing ability remained disturbed. A computed tomography (CT) scan at stroke onset revealed a hematoma in the left thalamus, but no cortical lesions were observed. Further, a single-photon emission CT (SPECT) scan showed decreased blood flow in the left thalamus, in the cortical region extending from the left superior temporal gyrus to the parietal lobe, and in the frontal lobe. It is possible that agraphia may have directly resulted from the thalamic lesion, but SPECT findings strongly suggested that a general decrease in left cortical function concomitant with a disruption of the thalamocortical and cortico-thalamocortical projection fibers produced these cognitive deficits.
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Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
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Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis 2013; 35:276-81. [PMID: 23548854 DOI: 10.1159/000348683] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/23/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. METHODS We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. RESULTS We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. CONCLUSIONS WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.
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Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Maeshima S, Osawa A, Nishio D, Hirano Y, Kigawa H, Takeda H. Diffusion tensor MR imaging of the pyramidal tract can predict the need for orthosis in hemiplegic patients with hemorrhagic stroke. Neurol Sci 2013; 34:1765-70. [PMID: 23430171 DOI: 10.1007/s10072-013-1330-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
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Abstract
We have investigated the prevalence of dry mouth among patients with autoimmune diseases other than Sjögren's syndrome. One hundred and forty-four patients, excluding patients with primary Sjögren's syndrome, were enrolled in this study. The volume of saliva secreted was measured with the screening technique for estimation of salivary flow, which uses a filter paper for diagnosing dry mouth. Disturbed salivary secretion was observed in 84 (58.3 %) of the 144 patients. In the case of patients free of Sjögren's syndrome, the prevalence of disturbed salivary secretion differed significantly among the disease groups (P < 0.05), with the prevalence being over 50 % in all disease groups other than the rheumatoid arthritis group and the highest in the systemic sclerosis group. There was significant positive correlation between the number of colored spots and oral visual analog scale score (r = 0.45, P < 0.0001). Autoimmune diseases can be accompanied by salivary gland dysfunction, regardless of the presence/absence of complication by Sjögren's syndrome. In the present study, the screening technique for estimation of salivary flow, which uses a filter paper for diagnosing dry mouth, was shown to be a useful means of detecting salivary gland dysfunction.
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Affiliation(s)
- Etsuko Maeshima
- Department of Health and Sport Management, Osaka University of Health and Sport Sciences, 1-1 Asashirodai, Kumatori-cho, Sennan-gun, Osaka, 590-0496, Japan,
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Maeshima S, Tereda T, Masuo O, Nakai K, Itakura T, Komai N. Multiple cerebral aneurysms with persistent primitive trigeminal artery. J Clin Neurosci 2012; 6:52-4. [PMID: 18639125 DOI: 10.1016/s0967-5868(99)90606-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/1996] [Accepted: 11/27/1996] [Indexed: 10/26/2022]
Abstract
We report a patient with a persistent primitive trigeminal artery (PPTA) detected incidentally during cerebral angiography for the ruptured aneurysm. Cerebral angiography revealed a PPTA and eight anterior circulation cerebral aneurysms. Although cerebrovascular fragility, hemodynamic stress and hypertension are well known as etiologic factors for development of cerebral aneurysms, there is a known association of aneurysms with a PPTA, fetal carotid-basilar anastomosis. Furthermore, this case is rare from the viewpoint of aneurysm multiplicity.
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Affiliation(s)
- S Maeshima
- Department of Neurological Surgery, Wakayama Medical College, 7-27, Wakayama 640, Japan
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